Managing your fatigue (tiredness) 1 Managing your fatigue (tiredness) This information is from the booklet Coping with fatigue (tiredness). You may find the full booklet helpful. We can send you a free copy see page 8. Contents Physical activity and exercise Diet Sleep Relaxation Complementary therapies Counselling Support More information and support Physical activity and exercise There s good evidence that physical activity, such as gentle strengthening exercises combined with some walking, can help to reduce the symptoms of fatigue. Being active may help to boost your appetite and give you more energy. It can also improve your general well-being, so it s important to try to exercise a bit, even if you don t feel like it. It s best to try to get a good balance between being active, exercising and getting plenty of rest. Before you start to do any physical activity or increase the amount you do, it s important to get advice from a healthcare professional. You may be a little bit nervous about getting started that s understandable. It s best to choose an activity or exercise that you enjoy. Try to maintain the amount of activity you do. However, if you have fatigue, this may not always be possible. Remember that some exercise is always better than no exercise. Simple goals, such as walking from the front door to the back door, may be an achievable goal for you. But try to increase your level of activity and build up the amount of exercise you do a bit at a time. Your cancer specialist or GP can advise you on the type and amount of activity that s safe for you. It s also important to discuss any other medical conditions you have, such as high blood pressure, diabetes or lung problems, as these may be affected by physical activity.
Managing your fatigue (tiredness) 2 You might find it helpful to get advice about exercise from a specialist cancer physiotherapist. Your GP or cancer specialist can arrange a referral for you. A physiotherapist can help you: build up your physical fitness improve your energy, strength, joint range, coordination and balance manage the side effects of treatment set some realistic goals for keeping active. The physiotherapist may suggest referring you for a supervised group exercise programme. These groups are run by healthcare professionals or experienced fitness trainers. Many people find the social side of being in a group enjoyable, and it may also help give you a bit more motivation to exercise. General suggestions for exercise It s helpful to set yourself some personal goals using the simple steps below. Try not to do too much, too soon. Plan some activity or light exercise into your day. Try some regular, light exercise, such as walking, and simple strengthening exercises like standing up and sitting down. These have been shown to reduce fatigue, and can help some people sleep better. Exercises such as yoga, qigong, pilates and tai chi may be particularly good, as they involve gentle movement, stretching, breathing and balance. Select exercise that you enjoy. If exercise is impossible, try to stay active in your daily routine. Pay attention to how your body reacts to activity and exercise. How did you feel? How well did you sleep afterwards? Drink plenty of fluids before, during and after exercise. Keep a record of your activities so that you and your healthcare team can monitor your progress. We can send you our booklet Coping with fatigue (tiredness), which includes a fatigue diary that you can use to write things down. Allow your muscles time to recover after activity by balancing activity with rest. Don t exercise if you feel unwell, are in pain or have any other symptoms that worry you, such as feeling breathless. Let your doctor know if you feel unwell or have worrying symptoms.
Managing your fatigue (tiredness) 3 Diet Eating well and keeping to a healthy weight will help you maintain or regain your strength, have more energy and have an increased sense of well-being. Here are some useful hints: Keep a diary of what and when you eat every day to see if you have more energy after certain meals. Try to take advantage of the times when your appetite is best. Drink plenty of fluids. If your taste changes, try different foods or eat the foods that taste best to you. Ask your doctor or nurse for any booklets or leaflets that give dietary advice. Ask your doctor to refer you to a dietitian, who can give you helpful ideas. We can send you our booklets about diet and eating problems, which have helpful hints. Sleep It s very important to try to keep to a normal sleep routine, even though your fatigue may make you feel like sleeping all the time. There are many ways to overcome fatigue, which your nurse or doctor can discuss with you. In the meantime, the tips on page 4 for a better night s sleep might help you to make the most of your rest periods.
Managing your fatigue (tiredness) 4 Tips for a better night s sleep Good-quality sleep is very important and may help to relieve fatigue, as well as reduce your need to sleep during the day. Go to bed and get up at about the same time every day. Having a long lie-in after a sleepless night can lead to a disrupted sleep pattern. Gentle exercise like walking and keeping your mind occupied with activities like reading, games or puzzles will help you feel naturally tired and ready for sleep. Get into a relaxing routine before bed. Try having a warm shower, reading or listening to soothing music. Listening to an audio book or a relaxation exercise on CD, tape or MP3 player can also be helpful. Make your bedroom a relaxing place to be in. Create an area that s dark, quiet and comfortable. Avoid large meals and stimulants like caffeine or cigarettes in the late evening. Try having a warm, milky drink before bed. Although a small alcoholic drink can help, too much alcohol can lead to disrupted sleep. Some medicines, for example, steroids, can cause sleeplessness. Ask your doctor or nurse whether you could take them earlier in the day. They may suggest you take them before 2pm. If you find it difficult to fall asleep or if you wake up during the night and can t get back to sleep again, get up and go to another room. Do something else, like read or watch TV, until you feel tired again. If you find that worries or concerns are keeping you awake, write them down. You can then speak to someone about them later. Be aware of how naps affect you. Some people find that daytime naps help them sleep better at night, while others sleep less well after them. Consider a warm bath, with relaxing oils or burning of essential oils such as lavender in a diffuser. You can get more information on sleeping well from the Royal College of Psychiatrists (rcpsych.ac.uk), which produces a range of useful information leaflets. Mental exercises can also help you to sleep. Below are a few exercises that you may like to try. They usually take about 10 minutes to do. Try to remember the lines of a song or poem. Make alphabetical lists of girls or boys names, countries, trees or flowers. Relive in detail a favourite experience. Write a letter in your mind. Use a relaxation exercise (see the next page). We can send you more information about difficulty sleeping. Call us on 0808 808 00 00 to order it.
Managing your fatigue (tiredness) 5 Relaxation Making time for activities that help you relax is very important in dealing with and preventing fatigue. Stress uses up energy and can make you feel more tired. It s very likely that you will feel more stressed than usual when you start your cancer treatment. The following suggestions may help you relax: Talk to others about anything that is worrying you. Try an activity such as reading, seeing friends and listening to music. This may help take your mind off worrying thoughts. If you can, try to avoid situations that make you anxious. If you can, take regular light exercise such as walking. Many people find it hard to relax and unwind, especially if the stresses and strains of the day are difficult to forget. Using specific relaxation techniques can help to relieve tension and boost your energy levels. There are two types of relaxation exercises: Physical exercises work on tension in your body. These include tensing and releasing each part of your body in turn and breathing exercises Mental exercises help to relax your mind. These include imagery exercises. You may want to experiment until you find the best exercise for you. You can ask if there is a nurse or other healthcare professional, such as an occupational therapist or psychologist, who can help you find the technique that s best for you. Using relaxation CDs, podcasts or DVDs can be a good way to learn different exercises. When you re ready to try a relaxation exercise, find a quiet, warm, dimly lit, relaxing place where you won t be disturbed, then lie or sit in a well-supported position. You ll get the maximum benefit from these techniques if you practise them for 5 15 minutes each day. There are instructions available on our website and on our CD called Relax and breathe. You may find some helpful techniques in tapes and CDs in your local library or you may want to try downloading relaxation podcasts from the internet.
Managing your fatigue (tiredness) 6 Complementary therapies There are a number of different complementary therapies that may help you cope with fatigue. They include: meditation acupuncture reflexology aromatherapy massage music therapy. You may need to pay for these but they are sometimes available on the NHS. Your GP, specialist nurse or a palliative care nurse may be able to refer you. You may also be able to get them through a cancer support group. Some doctors have been reluctant for their patients to use complementary therapies, mainly because they have not been properly tested in clinical trials. But many people who use them find that they re relaxing and help improve their general well being. They can also help you feel more in control of their health and of what s happening to them. We have a booklet called Cancer and complementary therapies, which has detailed information about various therapies and relaxation exercises. Counselling If you find it difficult to cope with your fatigue, or you feel anxious or depressed, you may find counselling helpful. Counsellors are trained to listen, and can help you talk through your feelings and find ways of dealing with them. They won t give advice or answers, but will help you find your own answers. You may find counselling particularly helpful if you aren t able to discuss your feelings and emotions with people close to you. Many hospitals have counsellors or staff who are specially trained to provide emotional support and counselling. You can ask your hospital doctor or nurse what services are available and ask them to refer you. Some GPs have counsellors in their practice, or they can refer you to one. If you would like to find out more about counselling, you can call our cancer support specialists on 0808 808 00 00. They can tell you more and let you know about services in your area. Not all counselling services are available on the NHS, so you may need to pay for them.
Managing your fatigue (tiredness) 7 Support Some people find it helps to talk to other people who have had fatigue. You may find talking to other people at the hospital helpful, or you could join a local support group, or share your experiences with others online. Support groups Most areas in the UK have cancer support groups. They are sometimes led by a healthcare professional. Other members of the group may be in a similar position to you. Some support groups have counsellors. Some people find groups helpful and they form close relationships with other members. However, other people get embarrassed or uncomfortable when talking about personal issues with strangers. Don t worry if groups aren t for you. Our cancer support specialists on 0808 808 00 00 can let you know about support groups in your area or you can find them at macmillan.org.uk/ supportgroups
Managing your fatigue (tiredness) 8 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. Visit macmillan.org.uk or call us on 0808 808 00 00, Monday to Friday, 9am to 8pm. You can order a copy of Coping with fatigue (tiredness), or any other cancer information, from be.macmillan.org.uk or by calling us. Hard of hearing? Use textphone 0808 808 0121, or Text Relay. Speak another language? We have telephone interpreters. We provide information in a range of languages and formats. Visit macmillan.org.uk/otherformats or call us. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Macmillan Cancer Support 2015. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Revised in December, 2015. Next planned review in 2018.